Rental Application | R Place For You! Bloomington's Rentals

Desired Rental Address/Building Name

Personal Information

First Name: *

Middle Initial:

Last Name: *

Date of Birth:

Birth Place: *

Current Address: *

City *

State *

Zip *

How Long at this Address: *

Current Home Phone: *

Cell Phone: *

Current Work Phone:

Current E-mail Address: *

Are you a Student?

Yes

No

What year & Major?

Do you have a pet?

Yes

No

If YES, what kind:

Names of Roommates:

Current Leasing Information

Have you ever rented a house or apartment: *

Yes

No

Present Landlord's Name:

Present Landlord's Phone #:

Previous Address:

Previous Address City/State/Zip:

Previous Landlord's Name:

Previous Landlord's Phone:

Legal Questions

Have you ever been evicted from a rental unit? *

Yes

No

If YES, why:

Have you ever been sued for non-payment of rent? *

Yes

No

If YES, why:

Do you currently have any outstanding judgments against you? *

Yes

No

Financial Background

Have you ever failed to timely pay rent? *

Yes

No

Have you ever filed for bankruptcy? *

Yes

No

Permanent Address Information (Parents)

Parents' Names:

Permanent Address:

Permanent City:

State:

Zip:

Permanent Phone:

Parent's Work Phone:

Payment Information

Share Your Responsibility for Rent?: *

Employment Information

Current Employer:

Current Occupation:

Full-Time or Part-Time:

Current Employer's Address:

Employer's Contact Name:

Current Employer's Phone:

Length of Time with Employer:

Current Salary:

Current Source of Income: *

Spouse's Employer:

Spouse's Employer's Address:

Spouse's Employer's Phone #:

Spouse's Wage:

Vehicle Information

Vehicle Make/Model:

Vehicle License Plate #:

State Vehicle is Registered:

Emergency Contact Information

Emergency Contact's Name: *

Emergency Contact's Relationship: *

Emergency Contact's Phone: *

Emergency Contact's Address: *

Emergency Contact's City: *

State: *

Zip: *

By typing "I agree" below, I certify that the answers are correct and that I/We have accurately completed this application. I/We authorize Deckard Homes and Apartments to conduct an employment/credit check and to obtain any other reports necessary concerning me/us as deemed necessary concerning my/our application and to verify all references. I/We understand that such reports may include and are not limited to my credit history, civil and criminal information, arrest records, rental history, employment and financial history, vehicle records, licensing records, and any other information deemed necessary. I/We declare that all information listed on this application is true and accurate.

Date *

I Agree *

(Type "I AGREE")

Applicant's Full Name: *

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